Youth Support
services have been run in a therapeutic manner and our centres are healing
communities.
All our transactions with residents, patients and clients are based on psychotherapeutic
principles. This means that not only are residents involved in formal therapy 'sessions',
but that everyday living experiences and conversations are used as opportunities for
informal therapy.

'Active' therapies are useful - art therapy and dance/ movement therapy
are obvious examples - but just as an activity can be used therapeutically in such
disciplines, so everyday activities can be a focus of therapy in a unit such as Youth
Support.

Our everyday management does not involve either sanctions or negative
reinforcement - we use only rewards and positive reinforcement. This forms part of our
behavioural programme and intervention is planned along these lines.

Unacceptable behaviour is dealt with by reasoning and encouragement. In
a recurrent or severe case a written warning will be issued and a copy sent to the
referring agency. If the patient does not respond to such measures and their behaviour is
a danger to themselves and others - they may be asked to leave the unit.

The following notes provide a guide-line as
to the philosophy of therapy and care within our units taken from the direction of working on the family background.

In working with young people from very disturbed family backgrounds or
in situations where they have been removed from their family of origin we can work through
the family by observing transference issues.

Freud was the first to formulate the concept that emotional illness
developed in relation to others. Thus arose the idea that it was possible to heal or
modify the relationship by creating a 'therapeutic' relationship with a therapist from
which parallels could be drawn to help the patient. This 'transference' process involves
two aspects - the therapist's interpretations and the patient's learning how to cope with
situations by inference.

patient <---------------> relative

| | | transference | | |

Patient <---------------> therapist

In working with the family that 'isn't there', transference ideas can be
applied to the 'group' both in the formal sense of the therapeutic groups within the unit
and informally looking at interactions in the 'living space' of a residential setting.

This works both ways. By observing emotional reactions and interchanges
the family norms and beliefs can be postulated. While at the same time knowledge of the
family background can help us to understand disturbed patterns of behaviour.

Example 1. Ann was placed in our residential unit after a long
history of physical and sexual abuse of both herself and other family members by several
male relatives.

In the unit Ann was never able to express her opinion on things, she
would never take sides. She always spent time with other girls who were distressed and
generally acted as peacemaker.

Ann's behaviour in the unit paralleled her position in the family - she
had been frequently pressed into taking sides - either with mother who tried to maintain a
facade of caring, despite having exposed her children to repeated abuse; or with
stepfather who had abused her. She was caught up in the double bind of feeling guilty at
having been abused and feeling sorry and responsible for the abusers. In a family where
there was no security and no idea of whom to trust, Ann could not know which side to take
in order to survive.

Therapy centred on correcting Ann's functioning within her 'replacement
family' - the unit - by encouraging her to trust that she would not be abused, feel safe
in expressing herself without criticism, and to be able to develop self confidence - and
subsequently to enable her to use this new role in the 'real world'.

Let us consider some of the issues which are prominent in the type of
family seen at the Youth Support unit.

Boundary issues. Many of the abusing families have almost non existent
boundaries. There is poor differentiation between individuals with a tendency for
personalities to fuse - If there is too much enmeshment -there is a loss of autonomy and
if the individuals are too disengaged - there is loss of intimacy.

In a disturbed family, members can oscillate emotionally between these
two extremes thus avoiding any real commitment to a relationship. Both extremes are
equally painful.

The boundary issue is seen to operate very graphically in the interplay
between teenage mother and baby.

Example 2 - Tracey showed an almost complete symbiosis with her
baby, who was almost used as a coat hanger - something to hang her feelings on - something
to wear her watch, to look pretty for her, to put on more weight than the other babies, to
laugh or be sick when Tracey wanted to attract attention or disrupt a conversation.

In the residential setting, interpersonal boundaries must be
scrupulously adhered to and echoed by consistent handling in terms of house rules and
'professional' caring.

In many of our families 'straight' communication between family members
has been difficult. The younger members have often been used as a pawn in communication
issues. Patterns may involve triangulations whereby parents avoid direct transactions by
relating through a child or collusions when the child is made to side with one parent -
often the abuser - against the other.

M ...... F
|
C

C->
|
F ->M

These patterns, if repeated in the residential unit can be extremely
destructive. Our clients are masters of manipulation and will consciously and
subconsciously be continually attempting to triangulate and collude - setting up one staff
member against another. We need to be constantly aware of these mechanisms and avoid being
enmeshed while maintaining close communication on an open 'honest' level.

It cannot be overestimated how powerful the pull to follow disturbed
patterns of behaviour can be and how much energy our patients use in trying to ensnare us
- trying to make us behave like the family of origin.

Our staff support group often dwells on this issue alone and is vital in
maintaining professional morale - it is the easy path to allow girls to recreate their
family of origin - it is a tough order to maintain the integrity of 'our family'.

Hence the residential unit can operate as a therapeutic community in
which by applying the principles of family therapy and transference issues patients can be
helped to work through the emotional scars of disturbance in their family of origin even
in the absence of the family members.